Skilled Care and Budgeted Staffing Nursing Worksheet
Consider this actual scenario (from my practice). You are a nurse manager of a 24-bed skilled nursing unit in a life-care community. The budgeting staffing is:
Day Shift – 1 RN, 1 LPN, and 4 CNAs
Evening Shift – 1 RN, 1 LPN, and 4 CNAs
Night Shift – 1 RN, 2 CNAs
To achieve your budgeted staffing, your FTEs are as follows (all FT and PT staff work every other weekend):
RN = (3) 1.0 FTE and (3) .4 FTE
LPN = (2) 1.0 FTE and (2) .4 FTE
CNA = (10) 1.0 FTE and (10) .4 FTE
You are able to fill your RN and LPN positions, however, you have difficulty hiring part-time CNAs. You hire students to cover weekends and experience nearly 100% turnover in 3-months. Subsequently, you have to hire agency CNAs at an increased cost and a negative impact on morale.
You learn that most CNAs work 2 full-time jobs to cover their expenses and call out quite frequently on both jobs. This practice increases the use of agency and overtime, and has a terrible effect on resident and staff satisfaction. Though you provide all the staff with a regular schedule at least 4 weeks in advance, the call-out rate for CNAs does not change.
You learn that your organization considers full-time as 60 hours biweekly (versus 80 hours). Employees scheduled (and work) at least 60 hours biweekly receive full benefits including family healthcare and prorated time off based on the number of hours they work up to 80 hours biweekly.
Your goal is to a) meet budgeted staffing goals, b) eliminate agency, and c) implement self-coverage for unplanned absences (staff switch or replace themselves with other staff without incurring overtime). What is your solution?
Patient Assessment & Health History Discussion
Post an explanation of the specific socioeconomic, spiritual, lifestyle, and other cultural factors associated with the patient you were assigned. Explain the issues that you would need to be sensitive to when interacting with the patient, and why. Provide at least five targeted questions you would ask the patient to build his or her health history and to assess his or her health risks.
JC, an at-risk 86-year-old Asian male is physically and financially dependent on his
daughter, a single mother who has little time or money for her father’s health needs. He
has ahx of hypertension (HTN), gastroesophageal reflux disease (GERD), b12
deficiency, and chronic prostatitis. He currently takes Lisinopril 10mg QD, Prilosec
20mg QD, B12 injections monthly, and Cipro 100mg QD. He comes to you for an
annual exam and states “I came for my annual physical exam, but do not want to be a
burden to my daughter.”